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The subtitle of my website used to be “A Canadian Studying Medicine at UQ”. As of late, that is no longer exactly true. It should be more like “A Canadian Junior Doctor Training In Australia”… but that’s not what this post is about.

Recently, a prospective student found this site through Google and emailed a few questions through. I remembered what it was like to be in her position, and so I typed up some of my thoughts. Since the advice is more about the situation, and rather general, I thought I would share it here in case there are any others making the decision. This was my reply:

Thanks for your email, I’m glad you enjoyed the site… it’s been something I did mostly to show my friends and family what’s going on, but I realize other people can find it too!

I can identify with your situation on finding info, and am happy to
provide my perspective on things. Keep in mind that it’s just one
person’s opinion though, and of course things can change. Part of the reason people are hesitant to give direct answers on these topics is because you are discussing university/government/health system policy four years down the line, and so much can change in that time.

It sounds as if your main concerns are about residency after
graduating. Let me be the first to say that I know what those
concerns are like. But at the same time, if you want to be a doctor,
you should do it, and cross whatever bridges you need to get it done. This route through med school will cost you a lot of things. There is the obvious, money, time, lost income (if you would have worked instead). Your friends lives will continue, while yours will feel like it stagnates in studentship. Also, it takes you to the other
side of the world, which is isolating in distance and believe it or
not, time. The time zone is very isolating. When you finish a day
and just want to talk to your family and friends at home, they’ll be
sleeping! It’s manageable though, and for Ontario people often they
are awake by evening here too. The world is a bit different here,
there are lots of small adjustments. Some things are better, some are not.

So after that sideline, I can answer your questions. The first thing
to know is that Australia’s medical education is not the same as North America. Here they follow a more British-type model. For example, if you want to be an internal med doctor in Canada, you go to med school for four years, then residency for five, and you’re done. Here the plan would be med school > one year internship > one year junior house officer > one year senior house officer > apply to become a registrar, hope the college accepts you for training (if not you can be a house officer again) > then start training as a “registrar” (of the college) for five or so years, then sit your exams when you’re ready. Then if you pass the exams then you become a “consultant” which is the equivalent of “attending” in Canada. Unlike Canada, where you get a residency that is a five year contract in one place, each job here is a separate contract, and you can move around between them. Importantly, your medical school isn’t really complete without an intern year. You get registered as “provisional” when you graduate, but it’s not until you finish intern year that you get “full registration”, which has its implications.

This has a couple of effects. Firstly. There are many more trainee
doctors around. In the hospital there are more hands on deck. Which means by the time it filters down to med students, there is literally no responsibility. You are simply a student, and can come and go as you please, with no duty beyond a social obligation to those willing to have you around. This can be liberating and frustrating at the same time. My younger brother is a doctor too, and he went through UBC. He had responsibility as a student, and got much more experience earlier on, which of course prepares doctors for a shorter training period. It’s as if the jobs of intern and JHO here are done by med students in third and fourth year in Canada. I am an intern now, which means I just graduated in December. I am loving having a role, and there is lots of support with other doctors around. I did a term in Canada in emergency, and it was basically me and an attending working. It was great, and much more like what I’m doing now. Secondly, it takes longer to go through the training program. That much is obvious. Juniors get paid better here than in Canada, but things are a lot more expensive, and you have to be a junior for longer.

Thirdly, and what answers your questions the most, is that not all
hospitals have interns. Only a few are accredited, because interns
have less experience, need to be supported by more senior staff, and hospitals need to have the patient base to provide enough exposure and training. This is the problem, the bottleneck. This is why you can’t just “go rural” and get a job. Australians are guaranteed an internship, somewhere in the state. Not everyone got where they wanted. Domestics graduating from UQ are Priority 1. You graduating from UQ are P4. Behind out of state domestics and NZ grads basically. The details are here http://www.health.qld.gov.au/medical/intern/Priority_Groups.pdf

Now, in my year, and keep in mind, this is what is most likely to
change, everyone who wanted to stay, is staying. Not everyone got a job, but nobody got deported kicking and screaming. Some didn’t get jobs, but knew they wanted to leave and so didn’t make a fuss. Some didn’t get a job and knew they wanted to stay, so they kept looking, contacting other hospitals, states, etc. Eventually, everyone who wanted to stay, that I know of, stayed. There are some with jobs that are hoping to leave their current jobs, after they find out if they get residency in Canada, which happens in March. I am not in this category, I am loving it here. I understand one of the factors making things more difficult is the disproportionate increase in international students in the cohorts. I hear that the classes after me have more and more, which may of course tighten things further. The university is not controlled by the health system, which means they can accept more than the health system is willing to train. If the health system doesn’t increase its training positions in accordance with the university spots, that’s when the squeeze will be felt worst. I don’t know how to predict these factors.

Internships in NZ and Singapore… my knowledge on this is admittedly second-hand. I understand NZ is an option, but I hear the health system there is having some troubles supporting its juniors. I don’t know for sure. In my second and third year there were some strikes and websites with juniors talking about how poorly they were treated and paid and the expectations put on them. It scared me out of looking there any further. Also, Singapore. I have a friend who went through the interview process for Singapore, and they were not very welcoming. He said they seemed very protective of who they accept, but not because it seemed desirable. The impression we had was that they wanted to make sure people would be staying. The interview panel seemed more concerned that he didn’t have family in Singapore and his
wife wasn’t Singaporean than any medical credentials he had. Also, of the Singaporeans that I know in my class, they all stayed in
Australia, if that says anything at all. One Singaporean expressed
his opinion that they were defensive because they know the working
conditions are poor and they want to make sure the candidates need to stay for reasons beyond work.

Coming back to Canada is not impossible, and I don’t think it will
ever be impossible. Canada is a big, growing country, and continues to import doctors. Doctors that can speak perfect English and relate to the people will naturally have every advantage for success. There is no preference because you are Canadian, but at least you don’t have to jump hurdles like writing your exams in a foreign language. I can’t imagine how difficult that would be! I have a few friends that already have secured jobs in Canada, and I’m sure I will have more come March. The fallback is the US. I understand that the US basically has a job for you. Because the hospitals run on a profit basis and juniors work much cheaper than attendings. So even though they have to pay to train them, a couple juniors can do more work (junior-type work though), and therefore be more profitable than one attending doing the same work. This means that US hospitals have more capacity, and that your Canadian citizenship isn’t necessarily a disadvantage. This is a case where if you’re willing to go wherever, you’ll find a job. I must say that my knowledge here is also mostly second hand, but I am pretty sure this is the case. To get into the US you need to do their exams USMLE, a program that takes years (you do it while being a student) and thousands of dollars, including flying back and forth for clinical exams and interviews. The health model in the US is also quite different, and would be something to consider closely.

So, to revisit one of the first things I said, if you want to be a
doctor, go for it, and do whatever it takes. If the worst happens and it costs you a bit more, or takes a year longer or you have to move to Tinytown USA, and you did it because you really wanted to do it, you’ll be happy. I hope this answers some of your questions. Feel free to ask me any others.